scholarly journals Association between Positive Airway Pressure Adherence and Healthcare Costs

2021 ◽  
Author(s):  
Jaejin An ◽  
Henry A Glick ◽  
Amy M Sawyer ◽  
Jessica Arguelles ◽  
Charles J Bae ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Healthcare Costs ◽  
Linear Models ◽  
Positive Airway Pressure ◽  
Research Question ◽  
Cost Savings ◽  
Obstructive Sleep ◽  
High Adherence ◽  
Average Standard Error ◽  
The Impact

Background: The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. Research Question: Are three-year healthcare costs associated with PAP adherence in participants from the Tele-OSA clinical trial? Study Design and Methods: Participants with OSA and prescribed PAP in the Tele-OSA study were stratified into three PAP adherence groups based on usage patterns over three years: (a) high (consistently ≥4 hours/night); (b) moderate (2-3.9 hours/night or inconsistently ≥4 hours/night); (c) low (<2 hours/night). Using data from three months of the Tele-OSA trial and 33 months of post-trial follow-up, average healthcare costs (2020 US dollars) in six-month intervals were derived from electronic health records and analyzed using multivariable generalized linear models. Results: Of 543 participants, 25% were categorized as having high adherence, 22% moderate adherence, and 52% low adherence to PAP therapy. Average (standard deviation) PAP use was 6.5 (1.0) hours, 3.7 (1.2) hours, and 0.5 (0.5) hours for the high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average [standard error] covariate-adjusted six-month healthcare costs ($3,162 [$240]) compared with the moderate ($3,658 [$369]) and low ($4,016 [$315]) adherence groups. Significant cost savings were observed between the high and low adherence groups ($854 [95% CI $158, $1,551]); savings between moderate and low adherence were non-significant ($359 [95% CI -$459, $1,176]). Interpretation: In participants with OSA, better PAP adherence was associated with significantly lower healthcare costs over three years. Findings support the importance of strategies to enhance long-term PAP adherence.

scholarly journals 448 Association between Positive Airway Pressure Adherence and Healthcare Costs

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A177-A177
Author(s):  
Jaejin An ◽  
Henry Glick ◽  
Jiaxiao Shi ◽  
Aiyu Chen ◽  
Jessica Arguelles ◽  
...  
Keyword(s):  
Healthcare Cost ◽  
Airway Pressure ◽  
Healthcare Costs ◽  
Positive Airway Pressure ◽  
Cost Savings ◽  
Study Cohort ◽  
Obstructive Sleep ◽  
High Adherence ◽  
The Impact

Abstract Introduction The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. We explored the relationship between 3-year PAP adherence and direct healthcare cost utilizing the Tele-OSA study cohort. Methods The Tele-OSA randomized clinical trial demonstrated improved PAP adherence in patients receiving automated feedback messaging regarding their PAP use versus usual care. The study enrolled patients at Kaiser Permanente Southern California, a large integrated healthcare system, from 2014–2015. Patients with moderate-severe OSA (Apnea Hypopnea Index [AHI] ≥15) from all study arms were consolidated, then stratified into PAP adherence groups based on mean PAP hours and PAP use patterns over 3-year follow-up period: (a) high adherence (consistent ≥4 hours/night); (b) moderate adherence (2–3.9 hours/night or inconsistent ≥4 hours/night); (c) low adherence (&lt;2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from Federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs during follow-up were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Results Of 374 patients (mean age 50 years, 63% male), 22% were categorized into high adherence, 18% moderate adherence, and 60% low adherence to PAP therapy. Mean (SD) hours of PAP use were 6.5 (1.1) hours, 3.7 (1.3) hours, and 0.3 (0.5) hours for high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average (SE) adjusted 6-month healthcare costs compared with other groups (High: $2,991 [$234]; Moderate: $3,604 [$412]; Low: $3,854 [$300]). Cost savings of high vs low adherence were $862 (95% CI $1540, $185). Cost savings of moderate vs low adherence were $250 (95% CI -$694, $1,193). Conclusion Better PAP adherence was associated with significantly lower healthcare costs over 3 years in patients with moderate-severe OSA. Findings support the importance of care strategies to enhance long-term PAP adherence for OSA therapy. Support (if any) The Tele-OSA Study was supported by AASM Foundation SRA Grant #: 104-SR-13

scholarly journals Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy

2021 ◽  
Vol 9 ◽  
Author(s):  
Najeh Daabek ◽  
Renaud Tamisier ◽  
Alison Foote ◽  
Hélèna Revil ◽  
Marie Joyeux-Jaure ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Research Question ◽  
Sleep Apnea Syndrome ◽  
Clinical Trial Registration ◽  
Pressure Therapy ◽  
Logistic Regression Models ◽  
Obstructive Sleep ◽  
Design And Methods ◽  
The Impact

Background: The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy.Research Question: The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions.Study design and methods: Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment.Results: Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score &gt; 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group).Interpretation: Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies.Clinical Trial Registration: The study protocol was registered in ClinicalTrials.gov, identifier: NCT03591250.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

scholarly journals Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea

2014 ◽  
Vol 40 (6) ◽  
pp. 658-668 ◽  
Author(s):  
Rafaela Garcia Santos de Andrade ◽  
Vivien Schmeling Piccin ◽  
Juliana Araújo Nascimento ◽  
Fernanda Madeiro Leite Viana ◽  
Pedro Rodrigues Genta ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Treatment Effectiveness ◽  
Obstructive Sleep ◽  
Pubmed Database ◽  
Osa Treatment ◽  
The Impact

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

scholarly journals 0896 Nutritional Status Improves Following The Implementation Of Positive Airway Pressure For The Treatment Of Obstructive Sleep Apnea In Youth With Down Syndrome

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A341-A341
Author(s):  
A Arputhan ◽  
M S Xanthopoulos ◽  
I E Tapia ◽  
P Hernandez ◽  
A Kelly
Keyword(s):  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Nutritional Status ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Obstructive Sleep ◽  
Beneficial Impact ◽  
The Impact

Abstract Introduction In typically developing youth, increases in body mass index (BMI) and rates of obesity accompany treatment of obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy regardless of baseline BMI and OSAS severity. Residual OSAS following adenotonsillectomy and overweight/obesity are common in Down syndrome (DS). We sought to examine the impact of positive airway pressure (PAP) on BMIZ in youth with DS and OSAS. Methods Baseline, 6, and 12 month height/length and weight as well as pre-PAP PSG data were abstracted from the Children’s Hospital of Philadelphia Sleep Center for patients with DS and OSAS initiated on PAP between 01/01/2014-07/11/01/2017 (N=73; Median age=6.6y IQR: 3.6-12.1; 52% White, 29% Black; 42% Male). BMIZ was calculated. Longitudinal mixed effects models adjusted for adherence from 0-6 months, baseline BMIZ, and baseline SpO2 nadir were used to evaluate change in BMIZ at months 6 and 12 and the impact of baseline BMIZ on trajectories. Results OAHI (median; IQR) at initiation was 15.9 (8.1-28.9) events/hour, SpO2 nadir was 83% (77-88), and BMIZ was 1.50 (0.94-2.34). No differences in BMIZ at 6 and 12 months compared to baseline BMIZ were found (p&gt;0.2 for both). Baseline BMIZ was associated with BMIZ at 6- and 12 months (β-coefficient=0.99; p&lt;0.0001); the increase in BMIZ at 12 mo (β-coefficient= 0.49, p=0.001) was offset with decreasing BMIZ (12mo*baseline BMIZ β-coefficient= -0.3; p&lt;0.0001); such that lower BMIZ was associated with increases in BMIZ while higher BMIZ was associated with decreases in BMIZ. Conclusion Initiation of PAP has a beneficial impact on nutritional status in youth with DS and OSAS. In youth who are at the lower end of BMIZ, BMIZ increases to a healthier status following the initiation of PAP, and in youth who are at the higher side of BMIZ, BMIZ decreases to a healthier status. Prospective studies are needed to elaborate on these associations. Support None

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